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The house that nurses built: Nurses design an innovative way to illustrate their professional practice model


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Nursing practice

Some people love diagrams and charts. The concentric circles and interpretive arrows make instinctual sense to them, clearly and simply illustrating a complex idea.

To the rest of us, these charts all too often look like monochromatic shapes that we must puzzle over in an effort to find the connection between the diagram and its real-life version.

Such can be the case for many nurses when they look at a schematic diagram that tries to show the integration of a professional nursing practice model with the overall institutional model of care. Many feel little connection between a flat diagram and how they care for their patients every day. So the nurses at The Medical Center of Central Georgia (MCCG) in Macon, led by Meryl Montgomery, RN, MSN, the hospital’s ANCC Magnet Recognition Program® (MRP) director, set out to design a different representation and came up with one that perfectly fits the hospital’s warm, Southern atmosphere: a traditional antebellum house.

Abandoning the old model

Figure 1 on p. 5 shows MCCG’s old model, which placed patient- and family-centered care in the middle, but most nurses had difficulty relating to it. Montgomery says nurses understood the general concepts but didn’t have a global understanding.

The hospital’s nurse practice council reviewed various nurse theorists to see whether nursing theory attached to the diagram would help explain how their nurses cared for patients within the institutional model of patient- and family-centered care. However, this led to increased confusion.

The nurses kept saying, ‘We know what we’re doing. Can’t you guys make it more simple?’ ” says Montgomery.

So the council chairs, all direct-care RNs, got together to design something that was meaningful, pictorial, and schematic and conceived a Georgia-style antebellum house to represent the integration of the nursing professional practice model with the hospital’s patient- and family-centered care model.

Bricks and mortar make a model

When designing the house, MCCG’s team considered the things that are necessary to construct a house and used these parts to illustrate how MCCG’s professional nursing practice model, or how nurses care for their patients, was integral to MCCG’s overall patient- and family-centered care model:

  • Foundation: The foundation is the base of the whole structure, so the model’s foundation is MCCG’s mission, vision, values, and philosophy.
  • Pillars: The pillars are what supports the structure. MCCG follows the Studer Group’s pillars, adapted for its particular environment.
  • Stairs: To come into the house, you must climb the stairs, which represent Benner’s model of novice to expert. To enter the house, you must grow in your job, moving from novice to competent to expert. This is represented by moving up the steps; as you learn more, you move to the next step.
  • Doors: The front door represents transformational leadership. “What is the way you get anything done in an organization?” says Montgomery. “It’s through transformational leadership.”
  • Windows: Windows let in light and fresh air, representing the innovative and fresh concepts of continuing education, professional development, interdisciplinary collaboration, and shared governance.
  • Roof: The most critical part of the house—because it covers and protects everything—is the roof. The roof represents the organizational patient- and family-centered care model.
  • Satellite dish: The satellite dish represents looking toward the future. “Obtaining our evidence-based practice and research not by looking at the past, but by looking into the future and searching for the best evidence,” says Montgomery.
  • Chimney: The chimney illustrates how performance and quality improvement underscore everything at MCCG. The chimney represents the visible outcomes, which can be seen by everyone. “Everything we do produces outcomes,” says Montgomery. “Outcomes can be clearly seen against the clear blue Georgia sky.”

Ringing in the new

Montgomery held a series of retreats with the chairs of the unit councils to discuss how each of their units delivered patient- and family-centered care. The chairs were divided into small groups. Each group had to write on a single page how it presented this model of care in its unique setting. This was then discussed in the larger group to identify commonalities among all units that could be applied to everyone as a whole.

Although everyone realized there were differences among the units’ care delivery models—for example, some units practice primary nursing whereas others use team nursing—they reached consensus regarding the overall commonalities of patient care across all units, Montgomery says. One of the commonalities is evidence-based practice. The units may find their evidence in different locations and apply it to different patient populations, but everyone practices based on evidence. Other commonalities included involving families and starting discharge planning on admission.

“So the nursing professional practice model is the same for all nurses at MCCG, though the delivery models at the unit—or ‘room level’—differ, accounting for the variety of different rooms in our house,” says Montgomery.

Decorating the house

The unit council chairs were responsible for taking information about the model back to their units, discussing it, and bringing feedback to the council as a whole. After several revisions, the design of the house was finalized.

The design was presented to the practice and executive councils for approval, and Montgomery says the rollout proved fairly simple as all the nurses had already been involved in the creation of the model. See Figure 2 on p. 5 for a picture of the final model.

Once the model was finalized, the team decided to build an actual representation of the model. Montgomery went to MCCG’s facility management and found someone who built doll houses as a hobby and could build a representation of the house. Once it was built, the house was personalized, and representations of actual objects at MCCG were added, such as its MRP quilt and miniature versions of the professional journals its nurses read. (See photos of the house below.)

Montgomery says the house sits on a cart in the library, where it can be checked out for staff meetings or any other time nurses want to see a 3-D version of the model they live every day.

The new model is much simpler for nurses to understand than the previous one, she says.

“It’s an intuitive model because they created it,” Montgomery says of the nurses. “And they created it by saying, ‘This is what we do.’ ”